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Herpes: How Did I Get it? How Can I Live With It?

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For most people, the diagnosis of genital herpes (Herpes Simplex
Virus 2 or HSV2) is a shock. For others, the diagnosis maybe a
confirmation of suspicions they have had about their own health
or their partner's behavior. Seeking to answer the question of
how the patient contracted the condition often leads to a search
for blame and then self-recrimination. Living with herpes is
something that initially may take some psychological adjustment
for some patients. It need not mean the end of your sex life or
that you will need to remain celibate for the rest of your life.

Firstly HSV2 and HSV1, better known as the cold sore virus, are
just two of a related group of seven viruses that are known to
infect humans. Others include the Varicella-Zoster virus,
commonly known as chicken pox and shingles. Diagnosis of
infection with either HSV1 or 2 can be established with a blood
test known as the Western Blot test; the upside of this test is
that a patient who does not have active lesions may be diagnosed
through the presence of antibodies to either strain. Accuracy of
this test is only 90-95% depending on the lab involved. Some
instances have occurred where patients were diagnosed with
either a false positive or a false negative. The most accurate
diagnosis is with a physician taking the top off a fresh lesion,
obtaining a swab from the base of the lesion and a lab growing a
viral culture from it. Extracting a viable swab from the lesion
can be quite painful for the patient.

HSV2 traditionally involved infections in genital areas, with
the virus lying dormant in the sacral nerve at the base of the
spine during periods when the patient is not experiencing
lesions. HSV1 traditionally involves infections around the mouth
and nose and lies dormant in the trigeminal nerve in the neck
during non-active phases of the disease. Current epidemiology
studies across the Western World indicate the incidence of HSV2
to be around one in eight people, or 12% of the population. Only
one in five of those with antibodies have been diagnosed.

In real terms, in a room containing forty people, five have HSV2
but only one knows they have it. A further three of the five may
have had an isolated symptom once or twice. This would have
appeared so insignificant that they mistook it for a pimple,
infected hair follicle or a boil. The final one in five is
someone who has never had a symptom and may never do so. For
this patient, and the other three undiagnosed patients,
accusations of infection (generally followed by accusations of
infidelity) from a partner are often met with counter
accusations and disbelief. A conservative estimate of the world
population with HSV1 antibodies and the ability to infect others
is around 90%. Of these, roughly 45% are symptomatic. If you
have been diagnosed with either infection, it is very possible
you contracted it from someone who has no idea they have it
themselves.

People have received the messages about safe sex and changed
some of their practices, believing that only penetrative sex
requires safe sex. Sexual health specialists now report that
half the new HSV diagnoses in clinics have been
microbiologically confirmed as HSV1 on the genitals, in the
general community it is now estimated that 20% of all herpes
infections in the genitals are in fact HSV1. On the plus side
for the infected patient, when the HSV virus is not living in
its ideal host environment (i.e. HSV1 infection of genitals,
oral HSV2 infection) infections have been generally documented
to be less severe and happen less frequently.

Another mistake many patients make, is assuming that they are
not infectious during a dormant or asymptomatic phase of their
disease. Studies have shown that even when a couple who are
clinically discordant (i.e. one is positive and the other is
negative) use what is recognized as gold standard treatment for
reduction of risk to partners, the rate of transmission in a
12-month period is still 10%. This management of infection
control involves the use of condoms during all sexual encounters
and complete abstinence from sex during the positive partner's
symptomatic phases. Interestingly, sexual health experts report
that if one partner has remained negative for 10 years in a
clinically discordant partnership, it is very unlikely that they
will contract the disease after this time. It is speculated that
they have some immunity/protection either natural or acquired
that science has not yet managed to identify.

A true primary infection of HSV2 can last for up to ten days, it
involves a systemic response, where all the glands in the body
are swollen, much as if the patient has influenza, as well as
the obvious genital burning, itching, pain with urination or
complete inability to urinate. Many patients think they are
presenting with a primary infection, but, severity of symptoms
indicates to the physician, this is in fact a recurrence. In
these cases the patient's primary infection would have been
asymptomatic, but, for some reason, they have become run down
and their immune system is not responding as it did when they
were first infected. These and subsequent recurrences of HSV2
are usually around five days in duration, unless there is a
serious immune system deficiency. In this case, the treating
physician should refer the patient for further testing.

Because HSV transmission requires skin-to-skin contact and viral
shedding to occur, typically an infection of HSV2 is
specifically confined to the genitals. Affected areas include
the vulva and labia in women and penis and scrotum in men, due
to penetrative intercourse being quite localized. Where a
patient has been infected with HSV1 on the genitals, the area is
usually larger and vesicle distribution more extensive due to
oral sex skin-to-skin contact covering a more extensive surface
area of the genitals. Both viruses may be treated effectively
with anti-viral drugs.

As stated earlier, each virus has its ideal host environment.
For the patient infected with HSV1 on the genitals, this means
subsequent infections are usually less virulent, and in some
cases may only ever recur once or twice in their lifetime. For
the patient infected with HSV2 on the genitals, the incidence of
recurrence can vary greatly. Recurrences are related to the
health of the immune system. Triggers may include stress, poor
diet, lack of sleep, sunburn and in some women, their menstrual
cycle. During the first year of infection, the number of
recurrences may range from one to twelve, with an average being
four to five. During subsequent years the immune system responds
better, the patient learns what will trigger a recurrence and
usually tries to avoid it. Eventually most patients can
experience as few as one to two recurrences per year. Also, as
the patient learns to better recognize the symptoms of an
impending recurrence, they are able to administer anti-viral
drugs earlier. This can minimize the length and duration of the
attack, and possibly prevent lesions altogether. It is important
for the patient to remember that despite avoiding a recurrence,
they are still shedding the virus and they are still potentially
infectious to their partner.

Maintenance doses of anti-virals may be taken daily to reduce
the number of recurrences. Up to 50% of patients on these
therapies report an absence of recurrences in a 12-month period.
Where this therapy is discontinued, patients almost certainly
will experience a recurrence within three weeks. This is
generally followed by a reduction in the number of annual
recurrences. There are a small number of female patients who
have required this maintenance therapy with anti-viral drugs
continuously since they first became available, over 15 years
ago, in earlier forms. As recurrences reduce in frequency and
severity, most patients eventually come to terms with their
diagnosis. For some, this is never the case, sexual health
physicians report that they need to refer between 10-20% of
their patients for further psychological counseling. This is in
spite the fact that they are very experienced with the disease
counseling required for this diagnosis.

What is important, regardless of how well patients appear to
cope with the initial diagnosis, is ensuring access to
information. This can be obtained readily and anonymously from
www.herpes.com, www.herpeshelp.com or www.genitalherpes.com
these sites contain up to date facts and also links to other
sites. These provide names and contact details of support
groups, local clinics and sexual health specialists. Although
HSV2 is a lifelong infection, with the right management and care
it is not necessarily symptomatic, nor should it impede the
patient from enjoying a loving and long-lasting, secure
relationship.

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